Background Endotracheal intubation is a life-saving intervention, and accurate placement of the endotracheal tube (ETT) is crucial in pediatric patients due to anatomical variability. Ultrasound offers a practical and safe alternative to chest X-ray (CXR) for verifying ETT placement. Objective To compare the diagnostic accuracy of ultrasound compared to CXR in localizing the ETT tip in pediatric patients. Methods A cross-sectional study was conducted from January to April 2025 in the Pediatric Intensive Care Unit and Cardiac Intensive Care Unit at Dr. Cipto Mangunkusumo Hospital. The study included children aged 1 month to 18 years intubated with either cuffed or uncuffed ETTs. A CXR was performed immediately after intubation, followed by ultrasound within 24 hours. ETT position was assessed based on CXR findings and tracheal ring alignment on ultrasound. Results A total of 89 patients were enrolled. Ultrasound demonstrated sensitivity of 88.6%, specificity of 73.7%, overall accuracy of 85.4%, positive predictive value (PPV) of 92.5%, and negative predictive value (NPV) of 63.6%. The area under the receiver operating characteristic curve (AUC) was 0.811. The positive likelihood ratio (LR+) was 3.37, and the negative likelihood ratio (LR–) was 0.16. Multivariate analysis identified ultrasound as a significant predictor of accurate ETT placement [odds ratio (OR) 7.75; 95%CI 1.29 to 4.74; P<0.001]. Conclusion Ultrasound is a feasible, reliable and accurate alternative to CXR for verifying ETT tip positioning in pediatric intensive care settings.

Background Nephrotic Syndrome (NS) is a progressive kidney disease in children that can lead to chronic kidney disease (CKD). Understanding the interactions between various risk factors is critical in developing new strategies to prevent the progression of CKD in pediatric patients with NS. Objective To determine the risk factors for the progression of CKD in children with nephrotic syndrome at Dr. Zainoel Abidin Public Hospital, Banda Aceh. Methods This analytical observational study with a cross-sectional approach was conducted from September 2021 to September 2023. Data were obtained from medical records of 52 children aged 2 to 18 years in the inpatient and outpatient wards of Dr. Zainoel Abidin Public Hospital, Banda Aceh who met the inclusion criteria. Bivariate analysis using the Chi-square and Fisher's tests and multivariate analysis using logistic regression test were performed. Results Of 52 subjects, most were male and over ten years of age; 53.8% of subjects had Stage 1 CKD. The majority of stage 3-5 of CKD cases had immunosuppressive toxicity and anemia, while the majority of all subjects had hyperfiltration and proteinuria. Risk factors for CKD progression in children with NS are Hypertension (OR 2.54; 95%CI 0.32 to 20.1; P=0.003), immunosuppressant toxicity with (OR 33.67; 95%CI 2.59 to 437.5; P=0.007) and anemia (OR 33.92; 95%CI 2.77 to 414.5; P=0.006). Conclusion Hypertension, immunosuppressant toxicity and anemia for CKD progression in children with NS.

Background The complete blood count test includes some markers of inflammation. Febrile seizures have been associated with inflammatory processes. Objective To investigate for possible relationships between the occurrence of febrile seizures (FS) and complete blood count (CBC) parameters. Methods Two hundred children aged 6-60 months presenting with fever at the Emergency Department between January 2022–August 2023 were included. These subjects were divided into a febrile seizures group (n = 100) and a control fever without seizures group (n =100). Demographic and complete blood count data were compared using logistic regression test. Results The frequency of febrile seizures was significantly higher in younger children [mean age 23.89 (SD 15.88) months]. The febrile seizures group had lower lymphocyte counts but significantly higher white blood cell (WBC), neutrophils, platelets, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) values than the control group. Multivariate analysis revealed that NLR (OR=0.84; P=0.001), PLR (OR=0.939; P=0.001), WBC (OR =0.773; P=0.001), neutrophil- platelet ratio (NPR) (OR=0.000; P=0.001), platelets (PLT) (OR=0.996; P=0.017), lymphocytes (OR=1.239; P=0.0001), and neutrophils (OR=1.047; P=0.022) had significant associations with febrile seizures while other parameters did not. Conclusion Patients with febrile seizures had significantly higher levels of inflammatory markers, such as NLR, PLR, WBCs, PLTs, neutrophils, and NPR, and lower levels of lymphocytes than children with fever but no seizures, as determined by complete blood count findings.

Background Although the prevalence of stunting in South Sumatera is estimated to be relatively high, there have been few studies to date on stunting and the factors associated with it in the region. Objective To determine the proportion of stunting in infants and toddlers aged 3-59 months at Mohammad Hoesin General Hospital (RSMH), Palembang, South Sumatera, and to identify medical and non-medical factors associated with stunting in these children. Methods A cross-sectional study was conducted at RSMH from April to September 2023. Stunting was defined according to the WHO standard and combined with a growth pattern that reflects chronic malnutrition. We recorded the proportion of stunting as well as data on several potential medical and non-medical risk factors of stunting. Results A total of 183 subjects met the inclusion criteria. The overall proportion of stunting was 65/183 (35.5%). The proportion of stunting was higher in boys (39.6%) and in children <2 years of age (38.2%). Medical risk factors significantly associated with stunting were infectious disease [OR 4.13 (95%CI 1.91 to 8.94); P=0.001] and chronic disease [OR 3.02 (95%CI 1.56 to 5.85); P=0.001]. The only non-medical factor significantly associated with stunting was low paternal education level [OR 2.45 (95%CI 1.17 to 5.15); P=0.016]. Conclusion During the study period, over a third of pediatric patients at RSMH experienced stunting. Infectious disease, chronic disease, and low paternal education level were significant risk factors that contributed to the occurrence of stunting.

Background Dengue infection is still rising globally despite the implementation of preventive efforts in many endemic countries. Monitoring the circulation of dengue virus (DENV) serotypes is not performed routinely in the Indonesian national surveillance program, primarily due to high cost and effort. Objective To evaluate the distribution of DENV serotypes based on serological profile and neutralizing antibody level against all four DENV serotypes in Jakarta, Indonesia. Methods This cross-sectional study was performed as part of a dengue vaccine effectiveness study, 10 years after a dengue vaccination program was initiated. It was conducted in five community public health centers in Jakarta in subjects aged 12 years and above who had not received the dengue vaccine. We collected serum samples and DENV neutralizing antibody titers were measured using a plaque reduction neutralization test (PRNT). Results Eighty healthy subjects with a median age of 15 (range 12-27) years were enrolled. The highest median antibody titer was that to DENV-2 [898 (range 29-91558) 1/dil], followed by that to DENV-3 [297.5 (range 10-36091); 1/dil], DENV-1 [288 (range 0-68237) 1/dil], and DENV-4 [164 (range 0-35812) 1/dil]. Neutralizing antibodies against the four DENV serotypes were found in all the 5 districts studied in Jakarta. A multitypic neutralizing antibody profile was observed in the majority (74/80 subjects; 92.5%). Three subjects were naïve. Conclusion All four dengue serotypes are widely circulating in Jakarta based on neutralizing antibody detection in the community, with the highest neutralizing antibody titer being against DENV-2, followed by DENV-3, DENV-1 and DENV-4.

Background Growing evidence suggests that childhood obesity has an impact on bone metabolism. Its entails of bone resorption, destruction of mature mineralized bone by osteoclasts followed by ossification, bone formation by osteoblasts, to maintain the dynamic nature of bone. Serum C-telopeptide of collagen cross-links (CTX) is considered a bone resorption marker while serum procollagen type I N-propeptide (PINP) is considered abone formation marker. Previous studies have reported the abnormality of these bone turnover marker in obese children. Objective To compare bone turnover markers and bone mineral density (BMD) in obese prepubertal children to those of normoweight children. Methods Bone metabolism was evaluated by measuring serum PINP as a bone formation marker and CTX level as a bone resorption marker by enzyme-linked immunosorbent assay. We used dual-energy X-ray absorptiometry (DEXA) scan to evaluate BMD in 60 prepubertal children with obesity and 30 healthy prepubertal normoweight children. Results The CTX was significantly higher in the case group compared to the control group (P=0.001). The case group also had significantly lower mean BMD (P=0.001) and BMD Z-score (P=0.001). C-telopeptide of collagen cross-links in the case group had significant positive correlations with waist circumference (P=0.001), BMI (P=0.001), and BMI Z-score (P=0.001). Significant negative correlations were found between waist circumference, BMI, and BMI Z-score with procollagen type I N-terminal propeptide, BMD, and BMD Z-score. Conclusion Obesity has a negative impact on bone health. Low BMD was associated with high CTX in prepubertal obese children.

Background Febrile seizure (FS) is the most common convulsion disorder without an intracranial abnormality in children aged 6 months to 5 years. Risk factors for FS vary from maternal illness during pregnancy to pediatric nutritional factors, such as micronutrient deficiency or history of exclusive breastfeeding (EBF). The WHO recommends breastfeeding for up to 6 months because breastmilk contains numerous protective factors that may influence immune system development. Objective To analyze the relationship between FS and EBF and other potential risk factors in children aged 6-60 months. Methods This paired case-control study used patient medical record data from Wangaya Hospital, Denpasar from 2019-2020. Subjects were included by a purposive sampling technique, matched by age group. Children aged 6 to 60 months with fever >38oC and seizures were allocated to the case group; those with fever but without seizures were allocated to the control group. Patients with intracranial disorders, born prematurely, or with incomplete medical record data were excluded. Data were analyzed using McNemar test, with P values <0.05 deemed to be statistically significant. Results Of 92 participants, 46 children were allocated into each group. There were no significant differences of gender, delivery method, or birth weight between the case and control groups. Febrile seizure was significantly greater in subjects with a family history of all seizures, overweight nutritional status, and who were non-EBF. McNemar analysis showed that EBF children had significantly lower risk of FS compared to non-EBF children (OR 0.74; 95%CI 0.15 to 3.55; P=0.017). Additionally, positive family history of FS was also a significant factor (OR 4.33; 95% CI 0.25 to 76.04; P=0.021), but not with the overweight nutritional status. Conclusion Exclusive breastfeeding are associated with reduced risk of FS in children aged 6 months to 5 years.

Background Thalassemia is a hemoglobin synthesis disorder that causes patients to need lifelong blood transfusions, leading to iron overload and alter organ function, including the liver. Hepcidin, produced by the liver, plays a role in iron homeostasis and should be increased in excess iron stores. However, the level decreases in thalassemia due to some factors, such as ineffective erythropoiesis and liver damage. Recent publications revealed that hepcidin could be associated with iron overload and also a marker of liver diseases. Objective To analyse the correlation between hepcidin level, markers of iron overload, and liver damage in beta-thalassemia major. Methods This cross-sectional study included all ?-thalassemia major age 2-18 years admitted to Dr. Mohammad Hoesin Hospital, Palembang, South Sumatera, who underwent blood transfusions from March to August 2022. We measured the level of iron overload markers, hepcidin, liver function test (LFT), and performed liver ultrasonography (USG). Results Of 97 subjects, median hepcidin level was 10.01 ng/mL and 68% of the subjects showed a decrease. The iron overload parameters were evaluated from serum iron levels (P=0.13), ferritin levels (P=0.90), and transferrin saturation (P=0.29) and 24.7% had abnormal liver USG findings. Spearman’s correlation revealed that only direct bilirubin (DB) (r=0.35; P=0.001) and liver USG (r=0.20; P=0.05) had positive correlations with decreased levels of hepcidin. Also, it had 91.7% sensitivity in predicting liver damage from ultrasound. Conclusion The hepcidin level was not significantly associated with iron overload markers.

Background Diphtheria cases continue to be reported in Indonesia, which has long been one of the countries with the highest number of diphtheria cases worldwide. One of Indonesia's province with the highest annual diphtheria cases is West Java. Dr. Hasan Sadikin General Hospital (RSHS) is one of the tertiary referral hospitals in Bandung, West Java, that treats several diphtheria cases annually. No study focused on the clinical characteristics of diphtheria cases in children admitted to RSHS between 2017 and 2021 yet. Therefore, this study sought to analyze that. Objective To find out the profiles of children < 18-year-old with diphtheria admitted in RSHS between 2017-2021. Methods This descriptive, cross-sectional study reviewed the medical records of diphtheria patients 0 to 18-year-old who were admitted to RSHS between year 2017 and 2021. Results Out of 45 subjects, 76% were males. The median of age was eight years old, ranging from 2 to 17 years. Most patients lived in urban areas and had normal anthropometry status, although some showed abnormal findings. The data showed that 44% had more than 3 days of onset until admission to the hospital, and the median length of stay was 9 days. The clinical characteristics showed that 91% of patients had pseudomembrane, also present with cough, common cold, hoarseness, stridor, and bull’s neck. As many as 44% of patients did not have complete basic immunization status. Complications found were airway obstructions, myocarditis, and sepsis, and 2 deaths were reported. Conclusion Pseudomembrane was found in the majority of patients. Most patients were over five years of age, and almost half number of the patients did not have complete basic immunization status, indicating the need for improved immunization and booster coverage.